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Chapter 44
Antiinflammatory and Antigout Drugs
1
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NSAIDsnon-steroidal anti-inflammatory drugs
Large and chemically diverse group of drugs with the following properties: Analgesic Antiinflammatory Antipyretic Antirheumatic
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NSAIDs: Mechanism of Action
Activation of the arachidonic acid pathway causes: Pain Headache Fever Inflammation
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NSAIDs: Mechanism of Action (cont’d)
Analgesia—treatment of headaches, mild to moderate pain, and inflammation Block the chemical activity of either or both
COX enzymes (prostaglandin [PG] pathway) and lipoxygenase (LT pathway)
Result in limiting the undesirable inflammatory effect of PGs
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NSAIDs: Mechanism of Action (cont’d)
Antipyretic—reduces fever Inhibits prostaglandin within the area of the
brain that controls temperature
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Chemical Categories of NSAIDs
SalicylatesAcetic acid derivativesCyclooxygenase-2 (COX-2)
inhibitorsEnolic acid derivativesPropionic acid derivatives
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NSAIDs: Salicylates
Salicylates also have antiplatelet activity Inhibit platelet aggregation Examples: aspirin, diflunisal (Dolobid),
others
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NSAIDs: Acetic Acids
indomethacin (Indocin)ketorolac (Toradol)diclofenac sodium (Voltaren)sulindac (Clinoril)tolmetin (Tolectin)etodolac (Lodine)
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NSAIDs: COX-2 Inhibitor
celecoxib (Celebrex) First and only remaining COX-2 inhibitor Indicated for osteoarthritis, rheumatoid
arthritis, acute pain symptoms, ankylosing spondylitis, and primary dysmenorrhea
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NSAIDs: Enolic Acid Derivatives
piroxicam (Feldene)meloxicam (Mobic)namumetone (Relafen)
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NSAIDs: Propionic Acids
fenoprofen (Nalfon)flurbiprofen (Ansaid)ibuprofen (Motrin, Advil, others)ketoprofen (Orudis KT)naproxen (Naprosyn, Aleve)oxaprozin (Daypro)
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NSAIDs: Indications
Analgesia (mild to moderate)Antigout effectsAntiinflammatory effectsAntipyretic effectsRelief of vascular headachePlatelet inhibition (aspirin)
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NSAIDs: Indications (cont’d)
Relief of mild to moderate painAcute goutVarious bone, joint, and muscle
painOsteoarthritisRheumatoid arthritis
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NSAIDs: Indications (cont’d)
Rheumatoid arthritis
Dysmenorrhea
Fever
Many other conditions
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Salicylates: Indications
Salicylic acid (aspirin)More potent effect on platelet aggregation and
thermal regulatory center in the brain Analgesic Antipyretic Antiinflammatory
Antithrombotic effect: used in the treatment of MI and other thromboembolic disorders
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Antigout Drugs: Indications
Gout: condition that results from inappropriate uric acid metabolism Underexcretion of uric acid Overproduction of uric acid
Uric acid crystals are deposited in tissues and joints, resulting in pain
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Antigout Drugs: Indications (cont’d)
allopurinol (Zyloprim) Used to reduce production of uric acid
colchicine Reduces inflammatory response to the
deposits of urate crystals in joint tissue
probenecid (Benemid), sulfinpyrazone (Anturane) Increase excretion of uric acid in the urine
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NSAIDs: Adverse Effects
GastrointestinalDyspepsia, heartburn, epigastric
distress, nausea GI bleeding* Mucosal lesions* (erosions or ulcerations)
* Misoprostol (Cytotec) can be used to reduce these dangerous effects.
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NSAIDs: Adverse Effects (cont’d)
RenalReductions in creatinine clearanceAcute tubular necrosis with renal
failure
CardiovascularNoncardiogenic pulmonary edema
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NSAIDs: Salicylate Toxicity
Adults: tinnitus and hearing lossChildren: hyperventilation and CNS
effectsMetabolic acidosis and respiratory
alkalosis may be present
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NSAIDs: Interactions
Serious interactions can occur when given with:AnticoagulantsAspirinCorticosteroids and other ulcerogenic drugsProtein bound drugsDiuretics and ACE InhibitorsOthers
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Herbal Products: Glucosamine and Chondroitin
Used to treat the pain of osteoarthritis Adverse effects
GI discomfort Drowsiness, headache, skin reactions
(glucosamine)
Drug interactions Enhance effects of warfarin May increase insulin resistance
(glucosamine)
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NSAIDs: Nursing ImplicationsBefore beginning therapy, assess for
conditions that may be contraindications to therapy, especially: GI lesions or peptic ulcer disease Bleeding disorders
Assess for conditions that require cautious usePerform lab studies as indicated (cardiac,
renal, and liver function studies, CBC, platelet count)
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Nursing Implications
Do NOT give salicylates to children and teenagers because of the risk of Reye’s syndrome
Because these drugs generally cause GI distress, they are often better tolerated if taken with food, milk, or an antacid to avoid irritation
Explain to patients that therapeutic effects may not be seen for 3 to 4 weeks
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Nursing Implications (cont’d)
Educate patients about the various adverse effects of NSAIDs, and inform them to notify their physician if these effects become severe or if bleeding or GI pain occurs
Inform patients to watch closely for the occurrence of any unusual bleeding, such as in the stool
Advise patients that enteric-coated tablets should not be crushed or chewed
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Nursing Implications (cont’d)
Monitor for therapeutic effects, which vary according to the condition being treated Decrease in swelling, pain, stiffness,
and tenderness of a joint or muscle area
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